The adrenal glands are located just on top of each kidney i.e. one on each side of your body. They are responsible for producing a variety of hormones (including aldosterone, cortisol, sex hormones and adrenaline) which regulate multiple body functions including salt and water balance, blood pressure, metabolism and the stress response. Growths on the adrenal gland (sometimes called ‘nodules’ or ‘tumours’) must be assessed:
1 – to establish whether there is excess of adrenal hormone(s)
2 – to assess the nature of the growth i.e. whether there are worrying features suggestive of cancer
This requires assessment in a specialist joint clinic with endocrinologists and endocrine surgeons: at the Hammersmith Endocrine Surgery we have a well-established pathway for such patients.
If you have a known adrenal growth or features suggestive of adrenal hormone excess, you will require several specialist blood tests. If you have not already had an adrenal scan or the scan could not give sufficient information about the growth, you may require further scans.
Surgery is required to treat adrenal hormonal excesses and/or tumours which are known or suspected to be cancer. In most cases this involves only removal of one adrenal gland and hormone supplements are therefore not required.
This is a tumour of the central part of the adrenal gland (the ‘medulla’) which is in fact a part of the sympathetic nervous system and produces the stress hormones adrenaline and noradrenaline. These hormones are usually triggered by fear and prepare the body for flight or fight, speeding up the heart rate diverting blood to the muscles and creating a sense of anxiety. In phaeochromocytoma, these hormones are produced by the tumour evoking the flight-fight response. This can occur at random, or be an exaggerated response to stress or exercise causing symptoms of palpitations, anxiety, a sense of impending doom, headache and increasing the blood pressure to dangerous levels.
The first part of treatment is to take medication to block the production of these hormones and prevent the dangerous elevation of blood pressure. Next, you will require surgery to remove the adrenal tumour (the medication can then be stopped).
Your surgical team will discuss the nature of surgery. In most people, keyhole (‘laparoscopic’) surgery is the best approach. This may be performed in two ways: via the front – ‘laparoscopic adrenalectomy’ or via the back – ‘retroperitoneoscopic adrenalectomy’. However, in some cases, the traditional approach of ‘open’ surgery via an incision in the abdomen may be appropriate.
The removed adrenal gland is then sent for analysis by specialist pathologists. Although most phaeochromocytomas are non-cancerous, some have a greater tendency to spread or come back. The risk of this can be assessed by reviewing the tumour under the microscope but all patients will go on to require follow-up blood tests on an annual basis at least.
These are very aggressive tumours of the adrenal gland but are fortunately rare. They often also result in excess production of one or more adrenal hormones.
At the Hammersmith Endocrine Surgery we specialise in the treatment of these tumours which may already have spread into adjacent organs at presentation. We work with specialist liver, pancreatic and vascular surgeons, as required, to achieve the best oncological result in the safest environment for these often complex tumours.
Excess production of cortisol from the adrenal cortex may result in obvious features of ‘Cushing’s’ syndrome with central obesity, stick thin legs and a swollen face along with diabetes, high blood pressure and thinning of the bones. However, most cases are more mild and so the outward manifestations are not seen whereas new diabetes or high blood pressure are.
Surgery with adrenalectomy to correct Cushing’s syndrome and reverse the damage, is usually in the form of removal of one adrenal gland containing the cortisol-producing nodule. In other patients whose excess cortisol arises from a trigger in the brain (pituitary gland), treatment is initially of the pituitary gland but if unsuccessful, the removal of both adrenal glands (bilateral adrenalectomy) is required.
This overproduction of aldosterone by the adrenal cortex is a common cause of high blood pressure. It may also cause low potassium levels.
The diagnosis is made using specialist blood tests (measuring renin and aldosterone) which must be done off blood pressure medications where possible. The next step is a ‘saline infusion test’ which is undertaken in the Hammersmith endocrine ‘PIU’ ward. If your diagnosis of Conn’s syndrome is confirmed, you will undergo a scan of your abdomen to give an indication of whether a single adrenal nodule is the cause (which could be treated with surgery).
Finally, to confirm whether the overproduction is indeed from one adrenal gland, a test sampling the hormone levels in the adrenal veins (‘adrenal venous sampling’) is recommended. Surgery with removal of an adrenal gland is then indicated if the venous sampling indicated production from one adrenal gland only.
At Hammersmith Endocrine Surgery, we have a specialist interest in patients with Conn’s syndrome. Our endocrinologists are very experienced in the diagnostics, radiologists in the venous sampling and surgeons in minimally invasive adrenalectomy.
The Hammersmith & Queen Charlotte’s Hospitals
Address: Du Cane Road
London W12 0HS
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